2. Lifestyle Recommendations

  • Professional support on how to stop smoking should be given, at every available opportunity, with provision of self-help material and referral to more intensive support, e.g. stop smoking services.
  • The JBS3 risk calculator emphasises the benefits for early smoking cessation and the diminishing but still substantial returns for quitting at an older age.
  • Patients should be offered behavioural counselling, group therapy, pharmacotherapy or a combination of treatments that have been proven to be effective.
  • Nicotine replacement therapy (NRT), varenicline or bupropion should be offered to people who are planning to stop smoking as part of an abstinent-contingent treatment in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date).
  • People who have heart or respiratory diseases, and those who live with them, should be made aware of the risks of both active and passive smoking (second-hand smoke).
  • For specific recommendations on quitting smoking in pregnancy and following childbirth, see NICE public health guidance 26.
  • The importance of stopping smoking during pregnancy should be emphasized and guidance from the National Institute for Health and Clinical Excellence (NICE) followed.[1]

Professional support to consume a diet associated with the lowest cardiovascular risk should be provided based on the following principles:

  • Intake of saturated fat to <10% of total fat intake (preferably in lean meat and low-fat dairy products)
  • Replace saturated fat with poly-unsaturated fat where possible
  • Consume five portions per day of fruit and vegetables
  • Consume at least two servings of fish (preferably oily) per week
  • Consider regular consumption of whole grains and nuts
  • Keep salt consumption <6 g per day
  • Limit alcohol intake to <21 units per week for men and <14 units per week for women
  • Avoid/reduce consumption of:
    • Processed meats or commercially produced foods which tend to be high in salt and trans fatty acids
    • Refined carbohydrates, such as white bread, processed cereals
    • Sugar-sweetened beverages
    • Calorie-rich, but nutritionally poor snacks, such as sweets, cakes and crisps
  • Children and young people should be supported to consume a diet based on the same principles.

Physical activity and exercise

  • An increase in overall levels of sustained physical activity and avoidance of prolonged sedentary behaviour are important for reduction of CVD risk.
  • Emphasise walking, cycling and other aerobic physical daily activities, at moderate intensity, as part of an active lifestyle, for at least 150 minutes per week in bouts of ≥ten minutes, or 75 minutes per week of vigorous physical activity, or a combination of the two.
  • Muscle-strengthening activities performed on at least two occasions per week

Exercise training
General population and those at low to moderate risk of CVD:

  • Exercise training, incorporating a warm up and cool down period, should be performed at moderate to high intensity two to three times per week for 30 to 40 minutes each time.
  • The mode of exercise should be aerobic and, where possible, continuous allowing for a steady progression in effort, e.g. walking programmes, cycling, jogging, swimming.
  • The time spent exercise training contributes to meeting the 150 minutes per week physical activity recommendation (as above).

Patients with established CVD and those considered at higher risk of CVD:

  • A more structured approach is needed in managing patients and in all cases, assessment and specific goal setting, with risk stratification, delivered by professionals skilled in health-related exercise is preferable.
  • Exercise on referral and community-based exercise initiatives are recommended for patients at risk of CVD.
  • Cardiac rehabilitation programmes are recommended for patients with established CVD and in those following a CVD event.